073406685-5-10-2023-02-CC-MMAR-CRPSLN-20230510135837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073406685
Report Date: 05/10/2023
Date Signed: 05/10/2023 01:58:55 PM

Document Has Been Signed on 05/10/2023 01:58 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	CREEK MIDDLE SCHOOL YOUTH PROGRAM - WCI, THE		FACILITY NUMBER:	073406685
ADMINISTRATOR:	ALMA REYES GUZMAN		FACILITY TYPE:	840
ADDRESS:	2425 WALNUT BLVD		TELEPHONE:	(925) 746-5536
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94596
CAPACITY:	61	CENSUS: 0	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Alma Guzman		TIME COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 5/10/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Annual inspection at The Creek Middle Youth Center WCI. LPA met with Director, Alma Guzman and explained the purpose of today's inspection. LPA was granted the inspection authority to enter the facility. Center is located in the premises of Walnut Creek Intermediate School. Operating days and hours are M - F from 3pm-6pm. Center is licensed to operate in Large Room, rooms 501, 502, 503, but is using the Large room only. There were no children present at time of inspection as the program had not started for the day yet. Indoor Space: The physical plant was inspected. LPA toured the premises with the Director. The classrooms, restroom, food storage areas and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Storage areas for poisons were locked and medications were kept in a safe place inaccessible to children. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed a working Fire extinguisher, Smoke and Carbon Monoxide Detectors. Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. The play equipment and surface of the outdoor activity space was in safe condition and free of hazards. There were no bodies of water observed. Drinking water is readily available to children. File Review: Children sign in/out procedures and logs were reviewed. A sample of Children and Staff files was taken for review. All files contained required documents. There was at least one staff present with current certification in Pediatric CPR and First Aid at the facility during inspection. Children's Roster LIC9040 and Personnel Report LIC500 was reviewed, and a copy obtained. Last Fire Drill was conducted on 11/2022.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CREEK MIDDLE SCHOOL YOUTH PROGRAM - WCI, THE	FACILITY NUMBER: 073406685
	VISIT DATE: 05/10/2023

NARRATIVE

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This facility provides Incidental Medical Services – IMS. Child brings their own medical device daily and facility does not store it in the premises. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

In the areas that were evaluated, no regulatory violations were observed.
Exit interview conducted and report was reviewed with the Director, Alma Guzman. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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